Behavioral Intervention for Obesity

(SWIFT Trial)

Overseen By Katherine Darling, PhD

Age: < 18

Sex: Any

Trial Phase: Academic

Sponsor: The Miriam Hospital

Must not be taking: GLP-1 receptor agonists

Disqualifiers: Cognitive impairment, Developmental delay, others

No Placebo Group All trial participants will receive the active study treatment (no placebo)

Compensation: Varies

Number of Visits: 20

64 Participants Needed

Trial Summary

Will I have to stop taking my current medications?

The trial requires that participants do not currently use glucagon-like peptide-1 (GLP-1) receptor agonists. Other medications are not mentioned, so it's unclear if you need to stop taking them.

What data supports the effectiveness of the treatment Weight Bias Internalization for obesity?

The research suggests that internalizing weight bias is linked to poor mental health and quality of life, which implies that addressing this bias could potentially improve these areas for individuals with obesity. ^{1 2 3 4 5}

Is the behavioral intervention for obesity, known as weight bias internalization, safe for humans?

The research articles provided do not contain specific safety data for the behavioral intervention for obesity, known as weight bias internalization. ^{2 3 4 6 7}

How is the treatment for Weight Bias Internalization different from other obesity treatments?

This treatment is unique because it focuses on addressing the internalized stigma and self-devaluation that people with obesity may feel, rather than just targeting weight loss. It aims to improve mental and social well-being by reducing negative self-perceptions, which can lead to better overall health outcomes. ^{2 3 4 5 8}

What is the purpose of this trial?

Weight stigma and weight bias internalization (WBI) are common among adolescents at higher weight statuses. WBI is associated with negative physical and mental health outcomes. The current study aims to test an intervention for weight stigma and WBI combined with an evidence-based adolescent weight management program. Eligible adolescents (13-17) will be assigned by chance to one of two groups: 1) a 4-week intervention focused on weight stigma and WBI followed by a 16-week behavioral weight management program; or 2) a 4-week health information control (to include non-weight-related health promotion topics such as smoking and skin cancer prevention) followed by the same 16-week weight management program but without the WBI and weight stigma content. Study outcomes will be assessed at the 4-week and post-treatment (20 week) timepoints.

Research Team

Katherine Darling, PhD

Principal Investigator

The Miriam Hospital

Eligibility Criteria

This trial is for adolescents aged 13-17 who are dealing with obesity and may experience weight discrimination. They should be interested in managing their weight and willing to participate in a program that includes discussions on weight stigma. Specific eligibility criteria were not provided, so additional factors may apply.

Inclusion Criteria

I am between 13 and 17 years old.

Have at least one caregiver available to provide consent and participate in sessions

Agree to study participation

Exclusion Criteria

I have cognitive issues that make group activities difficult.

Medical condition known to impact weight or that would otherwise prevent participation

Current participation in a weight management program or recent weight loss of 5% of body weight or more

Timeline

Screening

Participants are screened for eligibility to participate in the trial

2-4 weeks

Intervention

Participants undergo a 4-week intervention focused on weight stigma and WBI or a health information control, followed by a 16-week behavioral weight management program

20 weeks

20 weekly sessions (in-person)

Follow-up

Participants are monitored for safety and effectiveness after treatment

4 weeks

Treatment Details

Interventions

• Weight Bias Internalization

Trial Overview The study tests a new approach combining an intervention addressing weight stigma and internalization with a behavioral weight management program. Participants will either receive this combined intervention or just the weight management program after attending health information sessions unrelated to weight.

Participant Groups

Group I: Weight Bias Internalization + Behavioral Weight Management Intervention (WBI + BWM) Experimental Treatment 2 Interventions

WBI+BWM is a multicomponent behavioral weight loss intervention designed to address both weight bias internalization and weight status in adolescents. The first four sessions of the intervention will be focused on targeted WBI/weight stigma content, followed by 16 sessions addressing both weight stigma/WBI and evidence-based weight management strategies. Weekly meetings are scheduled for 75 minutes and are facilitated by a behavioral expert (e.g., PhD in clinical psychology). Caregivers attend 4 of the 20 weekly groups with their teens.

Group II: Health Information Control + Behavioral Weight Management Intervention (HIC + BWM) Active Control 1 Intervention

The first four sessions (weeks 1-4) of the HIC+BWM group will focus on health promotion for adolescent health concerns other than weight management (e.g., skin cancer prevention, smoking cessation). This health information control will allow for testing of the initial 4- week WBI intervention as compared to a contact-matched control. Following the four-week health education control, the remaining 16 sessions will focus on evidence-based weight management strategies. Caregivers attend 4 of the 20 weekly groups with their teens.

Who Is Running the Clinical Trial?

The Miriam Hospital

Lead Sponsor

Trials

252

Recruited

39,200+

Findings from Research

A study of 54 overweight and obese adults seeking weight loss treatment revealed significant levels of implicit, explicit, and internalized weight bias, which were linked to higher levels of depression, poorer body image, and increased binge eating.

While participation in weight loss treatment led to reductions in negative internalized and explicit weight bias, overall weight bias remained strong, suggesting that it may hinder individuals' ability to achieve optimal health and well-being.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Implicit, explicit, and internalized weight bias and psychosocial maladjustment among treatment-seeking adults. Carels, RA., Wott, CB., Young, KM., et al.[2022]

At least 44% of adults in the study reported mean levels of weight bias internalization (WBI), with the highest levels found in 52% of adults with obesity, indicating a significant prevalence of this issue across different populations.

Individuals with high WBI were more likely to be white, have lower education and income, be actively trying to lose weight, and have experienced previous weight stigma, highlighting the sociodemographic factors associated with internalized weight bias.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Internalizing Weight Stigma: Prevalence and Sociodemographic Considerations in US Adults. Puhl, RM., Himmelstein, MS., Quinn, DM.[2022]

In a study of 18,769 adults in a commercial weight management program, weight bias internalization (WBI) was found to be relatively high, indicating that many individuals internalize negative societal attitudes about weight, with an average WBIS-M score of 4.3.

WBI was notably higher among younger, female participants with higher BMIs, while it was lower in Black individuals and those with romantic partners, suggesting that demographic factors and the timing of weight stigma experiences play a significant role in WBI.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Weight bias internalization in a commercial weight management sample: prevalence and correlates. Pearl, RL., Himmelstein, MS., Puhl, RM., et al.[2023]

The Weight Bias Internalization Scale (WBIS) was developed and validated as a reliable tool to measure internalized weight bias among overweight and obese individuals, showing high internal consistency (Cronbach's alpha = 0.90).

Internalized weight bias, as measured by the WBIS, significantly correlates with negative outcomes such as low self-esteem, body image concerns, and mood disturbances, indicating its potential impact on mental health and eating behaviors.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Understanding self-directed stigma: development of the weight bias internalization scale. Durso, LE., Latner, JD.[2022]

The Weight Bias Internalization Scale (WBIS) demonstrated strong psychometric properties in a study of 1,158 individuals with overweight and obesity, confirming its reliability and validity as a measure of internalized weight bias.

Higher WBIS scores were associated with increased depressive and somatoform symptoms, particularly among women, individuals with obesity, and those with lower education or income, highlighting the scale's relevance in understanding the psychological impact of weight bias.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Weight bias internalization scale: psychometric properties and population norms. Hilbert, A., Baldofski, S., Zenger, M., et al.[2022]

A study of 942 Canadian adults found that weight bias internalization (WBI) is common across all body weight statuses, with higher scores in women and individuals with a BMI over 30, indicating a significant impact of societal attitudes on self-perception.

The majority of Canadians attribute obesity to behavioral factors, such as physical inactivity and overeating, which correlates with higher explicit weight bias, highlighting the need for public education on the multifaceted causes of obesity.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Weight bias internalization and beliefs about the causes of obesity among the Canadian public. Forouhar, V., Edache, IY., Salas, XR., et al.[2023]

Obese patients with binge eating disorder (BED) show significantly higher levels of internalized weight bias (IWB) compared to overweight individuals in the general population, indicating a strong impact of societal bias on this group.

IWB is closely linked to more severe eating disorder symptoms, fat phobia, and depression, while negatively affecting self-esteem, suggesting that addressing IWB could be crucial in treating BED effectively.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Internalized weight bias in obese patients with binge eating disorder: associations with eating disturbances and psychological functioning. Durso, LE., Latner, JD., White, MA., et al.[2022]

Weight bias internalization is significantly associated with poorer psychosocial, physical, and behavioral health outcomes, as shown in a meta-analysis of 149 studies involving nearly 18,800 participants.

Individuals with higher weight bias internalization experience worse mental health and are less likely to achieve weight loss, highlighting the need for targeted interventions to address this issue.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Weight Bias Internalization and Psychosocial, Physical, and Behavioral Health: A Meta-Analysis of Cross-Sectional and Prospective Associations. Romano, KA., Heron, KE., Sandoval, CM., et al.[2023]

References

1. United States pubmed.ncbi.nlm.nih.gov

Implicit, explicit, and internalized weight bias and psychosocial maladjustment among treatment-seeking adults. [2022]

2. United States pubmed.ncbi.nlm.nih.gov

Internalizing Weight Stigma: Prevalence and Sociodemographic Considerations in US Adults. [2022]

3. United States pubmed.ncbi.nlm.nih.gov

Weight bias internalization in a commercial weight management sample: prevalence and correlates. [2023]

4. United States pubmed.ncbi.nlm.nih.gov

Understanding self-directed stigma: development of the weight bias internalization scale. [2022]

5. United States pubmed.ncbi.nlm.nih.gov

Weight bias internalization scale: psychometric properties and population norms. [2022]

6. England pubmed.ncbi.nlm.nih.gov

Weight bias internalization and beliefs about the causes of obesity among the Canadian public. [2023]

7. United States pubmed.ncbi.nlm.nih.gov

Internalized weight bias in obese patients with binge eating disorder: associations with eating disturbances and psychological functioning. [2022]

8. England pubmed.ncbi.nlm.nih.gov

Weight Bias Internalization and Psychosocial, Physical, and Behavioral Health: A Meta-Analysis of Cross-Sectional and Prospective Associations. [2023]